AIMS The performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in diagnosing acute decompensated heart failure (ADHF) among patients presenting with breathlessness is markedly impaired in the presence of atrial fibrillation (AF). We evaluated the diagnostic performance of mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin T as possible alternative markers for discrimination of ADHF in this setting. METHODS AND RESULTS Breathless patients (n = 1107) were prospectively and contemporaneously recruited in emergency departments in Singapore and New Zealand. The diagnoses of ADHF and presence of AF were adjudicated by two clinician specialists, blinded to MR-proADM, NT-proBNP and high-sensitivity cardiac troponin T (hs-cTnT) results. MR-proADM exhibited strong discrimination of ADHF with little change in performance irrespective of the presence of AF (area under the curve 0.83 in non-AF vs. 0.76 in AF) compared to NT-proBNP (0.91 vs. 0.71) and hs-cTnT (0.83 vs. 0.62), respectively. The accuracy of MR-proADM (73.3%) for diagnosing ADHF among patients with AF was superior to both NT-proBNP (61.6%) and hs-cTnT (64.6%). The superior performance of MR-proADM remained apparent when data from Singapore and New Zealand were analysed separately. CONCLUSION In the presence of AF, MR-proADM showed greater discrimination and accuracy, and less impairment in performance compared to that in non-AF cases, for the diagnosis of ADHF, compared to the guideline-endorsed NT-proBNP.

中文翻译：

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在存在心房颤动的情况下，用于诊断急性心力衰竭的中部区域促肾上腺髓质素的性能优于N端促B型钠尿肽。

目的在存在心房颤动（AF）的患者中，患有呼吸困难的患者在诊断急性失代偿性心力衰竭（ADHF）时，N末端前B型利钠尿肽（NT-proBNP）的性能明显受损。我们评估了中间区域肾上腺髓质素原（MR-proADM）和心肌肌钙蛋白T在这种情况下作为鉴别ADHF的可能替代标志物的诊断性能。方法和结果在新加坡和新西兰的急诊科中，前瞻性并同时招募了呼吸困难的患者（n = 1107）。两名临床专家对ADHF和AF的存在进行了诊断，对MR-proADM，NT-proBNP和高敏感性心肌肌钙蛋白T（hs-cTnT）结果不了解。与NT-proBNP（0.91 vs. 0.71）和hs-cTnT相比，MR-proADM表现出对ADHF的强分辨力，并且无论AF是否存在（非AF下曲线区域面积0.83，AF下曲线区域0.76），性能几乎没有变化。 （分别为0.83和0.62）。MR-proADM（73.3％）在房颤患者中诊断ADHF的准确性优于NT-proBNP（61.6％）和hs-cTnT（64.6％）。当分别分析来自新加坡和新西兰的数据时，MR-proADM的优越性能仍然显而易见。结论与指南批准的NT-proBNP相比，在存在AF的情况下，与非AF病例相比，MR-proADM对ADHF的诊断具有更高的辨别力和准确性，并且对功能的损害较小。71）和hs-cTnT（分别为0.83和0.62）。MR-proADM（73.3％）在房颤患者中诊断ADHF的准确性优于NT-proBNP（61.6％）和hs-cTnT（64.6％）。当分别分析来自新加坡和新西兰的数据时，MR-proADM的优越性能仍然显而易见。结论与指南批准的NT-proBNP相比，在存在AF的情况下，与非AF病例相比，MR-proADM对ADHF的诊断具有更高的辨别力和准确性，并且对功能的损害较小。71）和hs-cTnT（分别为0.83和0.62）。MR-proADM（73.3％）在房颤患者中诊断ADHF的准确性优于NT-proBNP（61.6％）和hs-cTnT（64.6％）。当分别分析来自新加坡和新西兰的数据时，MR-proADM的优越性能仍然显而易见。结论与指南批准的NT-proBNP相比，在存在AF的情况下，与非AF病例相比，MR-proADM对ADHF的诊断具有更高的辨别力和准确性，并且对功能的损害较小。